title: Safety and effectiveness of repeat arterial closure using the AngioSeal device in patients with hepatic malignancy.
abstract: OBJECTIVE
  To retrospectively evaluate the safety and effectiveness of the use of the AngioSeal device for repeat arterial closure in patients with hepatic malignancy.
  
  
  METHODS
  A retrospective analysis of patients with hepatic malignancy who had undergone repeated arterial closure with the AngioSeal device was performed. All charts for patients undergoing transarterial chemoembolization or TheraSphere radioembolization were reviewed for the method of hemostasis and the number of arterial closures. A total of 53 patients (58.5% men, 41.5% women; mean age, 58.7 years) had repeat AngioSeal arterial puncture closure after chemoembolization or TheraSphere treatment. Percutaneous closure of the common femoral artery with the AngioSeal device was performed in accordance with the manufacturer's recommendations. The patients were examined for complications on follow-up. Effectiveness was defined by the ability to obtain satisfactory hemostasis. Safety was assessed by the absence of groin complications and by vessel patency on follow-up angiograms of the puncture site obtained at subsequent liver-directed therapy sessions.
  
  
  RESULTS
  Fifty-three patients in this study group had a total of 203 common femoral artery punctures. There were a total of 161 closures with the AngioSeal device (79.3%): 58 (36%) single closures and 103 (64.0%) repeat closures. Of the 161 attempts at AngioSeal closure, there was one closure failure in the single-puncture group, yielding a success rate of 98.3%; and one closure failure in the repeat-puncture group, yielding a success rate of 99%. In these two patients, hemostasis was achieved with traditional manual compression without the need for any other device, and no complications were noted. The overall success rate of AngioSeal device closure was 98.7%.
  
  
  CONCLUSIONS
  The repeat use of the AngioSeal closure device is safe and effective in patients with hepatic malignancy undergoing regional oncologic interventional procedures.
authors.affiliation: Department of Radiology, Medical College of Wisconsin-Froedtert Memorial Lutheran Hospital, 9200 West Wisconsin Avenue, Room 2803, Milwaukee, WI 53226, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hieb
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Neisen
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hohenwalter
authors.forename: Jim A
authors.initials: JA
authors.lastname: Molnar
authors.forename: William S
authors.initials: WS
authors.lastname: Rilling
mesh_terms: D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome